Outcome of pregnancy in renal allograft recipients

To evaluate risk factors affecting pregnancy, perinatal outcomes and graft condition in women who underwent renal transplantation. Retrospective study of 34 pregnancies in 28 renal recipients followed in a single tertiary center from January 1989 to January 2007. Pregnancy outcome, kidney allograft function, maternal complications and perinatal outcomes were evaluated in these patients. Mean maternal age at time of pregnancy was 27 +/- A 5.1 years (18-37) and the interval between transplant and pregnancy varied between 1 and 134 months (mean 51.3 +/- A 34.2). Most pregnant women (25/28) were submitted to triple immunosuppression during the entire pregnancy. The fetal outcome included 27 live births (79.4%), 2 stillbirths (5.9%), 3 spontaneous abortions (8.8%) and 2 therapeutic abortions (5.9%). The most frequent maternal complications were hypertension in 18 pregnancies, 2 of which ended in pre-eclampsia; urinary tract infections in 10 pregnancies; gestational diabetes mellitus in 3, anemia in 3 and 2 acute graft rejections. The major fetal complications observed consisted of four (13. 8%) intrauterine growth restrictions and two (6.9%) stillbirths. Vaginal delivery occurred in 10 women (34.5%); in the other 19 (65.5%), a cesarean section was performed. Of the 27 successful pregnancies, 11 (40.7%) resulted in term deliveries and 16 (59.3%) in preterm deliveries (range 31-39 weeks). The mean birth weight of the offspring was 2,465 g (range 1,300-3,530). There were no major perinatal complications, but two allograft rejections occurred after pregnancy. This series results are in agreement with those in other studies. Even though pregnancy does not seem to adversely affect short-term renal allograft function, risks of obstetric and perinatal complications seem to be increased. Further studies of long term graft function and pediatric follow-up are needed.